Haw. Code R. § 16-12-7.3 - Filing and approval of policies and certificates and premium rates
(a) An issuer shall not deliver or issue for
delivery a policy or certificate to a resident of this State unless the policy
form or certificate form has been filed with and approved by the commissioner
in accordance with filing requirements and procedures prescribed by the
commissioner.
(b) An issuer shall
file any riders or amendments to policy or certificate forms to delete
outpatient prescription drug benefits as required by the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 only with the commissioner in
the state in which the policy or certificate was issued.
(c) An issuer shall not use or change premium
rates for a Medicare supplement policy or certificate unless the rates, rating
schedule, and supporting documentation have been filed with and approved by the
commissioner in accordance with the filing requirements and procedures
prescribed by the commissioner.
(d)
(1) Except as provided in paragraph (2) of
this subsection, an issuer shall not file for approval more than one form of a
policy or certificate of each type for each standard Medicare supplement
benefit plan.
(2) An issuer may
offer, with the approval of the commissioner, up to four additional policy
forms or certificate forms of the same type for the same standard Medicare
supplement benefit plan, one for each of the following cases:
(A) The inclusion of new or innovative
benefits;
(B) The addition of
either direct response or agent marketing methods;
(C) The addition of either guaranteed issue
or underwritten coverage; and
(D)
The offering of coverage to individuals eligible for Medicare by reason of
disability.
(3) For the
purposes of this section, a "type" means an individual policy, a group policy,
an individual Medicare Select policy, or a group Medicare Select
policy.
(e)
(1) Except as provided in subparagraph (A),
an issuer shall continue to make available for purchase any policy form or
certificate form issued after the effective date of this section that has been
approved by the commissioner. A policy form or certificate form shall not be
considered to be available for purchase unless the issuer has actively offered
it for sale in the previous twelve months.
(A)
An issuer may discontinue the availability of a policy form or certificate form
if the issuer provides to the commissioner in writing its decision at least
thirty days prior to discontinuing the availability of the form of the policy
or certificate. After receipt of the notice by the commissioner, the issuer
shall no longer offer for sale the policy form or certificate form in this
State.
(B) An issuer that
discontinues the availability of a policy form or certificate form pursuant to
subparagraph (A) shall not file for approval a new policy form or certificate
form of the same type for the same standard Medicare supplement benefit plan as
the discontinued form for a period of five years after the issuer provides
notice to the commissioner of the discontinuance. The period of discontinuance
may be reduced if the commissioner determines that a shorter period is
appropriate.
(2) The sale
or other transfer of Medicare supplement business to another issuer shall be
considered a discontinuance for the purposes of this subsection.
(3) A change in the rating structure or
methodology shall be considered a discontinuance under paragraph (1) unless the
issuer complies with the following requirements:
(A) The issuer provides an actuarial
memorandum, in a form and manner prescribed by the commissioner, describing the
manner in which the revised rating methodology and resultant rates differ from
the existing rating methodology and existing rates; and
(B) The issuer does not subsequently put into
effect a change of rates or rating factors that would cause the percentage
differential between the discontinued and subsequent rates as described in the
actuarial memorandum to change. The commissioner may approve a change to the
differential which is in the public interest.
(f)
(1)
Except as provided in paragraph (2), the experience of all policy forms or
certificate forms of the same type in a standard Medicare supplement benefit
plan shall be combined for purposes of the refund or credit calculation
prescribed in section
16-12-7.
(2) Forms assumed under an assumption
reinsurance agreement shall not be combined with the experience of other forms
for purposes of the refund or credit calculation.
(g) An issuer shall not present for filing or
approval a rate structure for its Medicare supplement policies or certificates
issued after the effective date of the amendment of this regulation based upon
a structure or methodology with any groupings of attained ages greater than one
year. The ratio between rates for successive ages shall increase smoothly as
age increases.
(h) An issuer shall
file a certification signed by an officer of the issuer stating that the
contract, policy, or certificate meets the minimum benefit standards required
in article 10A of chapter 431, HRS, and this chapter. In determining the
accuracy of any certification, the commissioner may require the issuer to
submit any additional information.
Notes
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